Hi Todd,
My view would be if you are completely convinced it is viral
meningitis - no antibiotics. If you are treating for bacterial
meningitis (even for the remote possibility of bacterial meningitis),
then use meningitic doses of antibiotics.
David
________________________________________________________
David F. Soglin, M.D.
Chairman, Department of Pediatrics
John H. Stroger, Jr. Hospital of Cook County (Cook County Hospital)
Cook County Health and Hospitals System
1900 W Polk Suite 1100
Chicago, IL 60612
Telephone: (312)864-4506
Fax: (312)864-9720
Quoting [log in to unmask]:
> Ok...I am trying to summarize this as briefly as possible...
>
> I had a 5 week old, nl birth hx, no maternal herpes/lesions, feeding well,
> temp at home 101.6 Axillary, no fever in ER.
> Pt. looked well, NL exam except classic viral exanthem.
> I did a "complete sepsis w/u":
> WBC 18 nl diff, lytes nl, UA nl, serum glucose from lytes 75
> CSF 64 WBC's, 2 RBC's, CSF Glucose 38, CSF protein 78, CSF gram stain -
> CXR -
>
> I ordered 50mg/kg of ampicillin and 50 mg kg of cefotaxime and called for
> admission. The peds hospitalist, a great guy, asked if I would mind to
> increase my amp dose to 100mg/kg and to add on acyclovir.
> I complied, not the biggest deal in the world.
> To me, this was 64 WBC's, NL gram stain, with obvious viral exanthem,,
> clinically I was thinking this was most likely a viral meningitis.
>
> Turns out the CSF Enteroviral PCR was +.
>
> The PICU attending, kindly asked me why I did not give 100mg/kg of Amp
> right away, rather than 50mg/kg that I originally ordered. And this was asked
> in a very non confrontational manner.
>
> My answer was, as above, classic viral exanthem, 64 WBC's, nl CSF gram
> stain, and this appeared to be a viral meningitis. PICU attending's response
> was, basically, that he felt that if there is ANY abnormality on the tap we
> should start with the higher amp dose in the ER.
>
> I am a believer of making errors in the side of caution (to a degree, of
> course), and I have been thinking about this for the past 2 hours now....
>
> To my Peds ER colleagues....do you give 100mg/kg of amp with any, and I
> mean ANY abnormality to the CSF, whatsoever.....
>
> Thanks for considering this....
>
> -Todd Z
>
>
> Dr. Todd Zimmerman
> Medical Director, Pediatric Emergency Medicine
> St. Alexius Medical Center/Alexian Brothers Medical Center
> Midwest Emergency Associates
> CMO, PIRRGA
>
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>
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